Billing and Coding: GlycoMark Testing for Glycemic Control (A57237)

Related Local Coverage Determination (LCD)
L36864-GlycoMark® Testing for Glycemic Control

Contractor Name	Contract Number	States
Noridian Healthcare Solutions, LLC	01111 - A and B MAC	California - Entire State
	01112 - A and B MAC	California - Northern
	01182 - A and B MAC	California - Southern
	01211 - A and B MAC	American Samoa Guam Hawaii Northern Mariana Islands
	01212 - A and B MAC	American Samoa Guam Hawaii Northern Mariana Islands
	01311 - A and B MAC	Nevada
	01312 - A and B MAC	Nevada
	01911 - A and B MAC	American Samoa California - Entire State Guam Hawaii Nevada Northern Mariana Islands

Article Information

Article ID Number: A57237 Status: A-Approved

Article Title: Billing and Coding: GlycoMark Testing for Glycemic Control

Original Article Effective Date: 10/01/2019

Revision Effective Date: 10/01/2019

Article Text:

The following coding and billing guidance is to be used with its associated Local coverage determination.

To receive a GlycoMark test denial, please submit the following claim information:

CPT^® code 84378 or 84999
An Advance Beneficiary Notice (ABN) is not required for statutorily excluded services

For a voluntary issued ABN, append with GX modifier
To indicate a statutorily excluded service, append with a GY modifier

Coding Information

Bill Type Codes:
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

999 Not Applicable

CPT/HCPCS Codes:

Group 1 Paragraph:
N/A

Group 1 CPT Codes:

84378 SUGARS (MONO-, DI-, AND OLIGOSACCHARIDES); SINGLE QUANTITATIVE, EACH SPECIMEN

84999 UNLISTED CHEMISTRY PROCEDURE

ICD-10 Codes That Are Covered

N/A

XX000 Not Applicable

ICD-10 Codes That Are Not Covered
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation

10/01/2019 R2
Updated to indicate this article is an LCD Reference Article.

10/01/2019 R1
10/01/2019: This article is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs and incorporate into related Billing and Coding Articles. Regulations regarding billing and coding were removed from the CMS National Coverage Policy section of the related GlycoMark Testing for Glycemic Control LCD L36864 and placed in this article. Under CPT/HCPCS Modifiers added modifier GX and GY.